Purpose of a Fall Risk Tool

• Maintaining patient safety is a priority while in the hospital environment

• The risk for falls is greater in the hospital environment due to physiological factors, medications, toileting needs, and use of equipment

• JC requires assessment and reassessment of a patient’s risk for falls, as well as specific interventions to address any risks that are identified

Procedure

• All patients are assessed by a Registered Nurse to determine fall risk. Assessments occur:

– At the time of admission

– Every shift thereafter

– Change of caregiver

– Change in patient condition

– With any change in level of care

– Following a fall

GRAF PIF Tool

• GRAF PIF: General Risk Assessment for Pediatric Inpatient Falls

• Developed by Elaine Graf – Children’s Memorial Hospital, Chicago

– 2005

• Positive features include: – Fewer patients are categorized as HIGH risk

– Reduction of alert fatigue

– Opportunity for more targeted prevention interventions

– More specific education for families

GRAF PIF Score Worksheet Score

Length of Hospital Stay 1-4 days 0

5-9 days 1

10 or greater 2

IV / Heparin Lock No 1

Yes 0

PT / OT No 0

(recent past, current or expected in near future) Yes 1

Anti-seizure medication, given for any reason No 0

Yes 1

Acute or chronic orthopedic, musculoskeletal diagnoses

No 0

Yes 1

History of fall within past 1 month No 0

Yes 2

Fell During this Hospitalization No 0

Yes 2

Total Score

TOTAL SCORE of 2 or greater indicates HIGH risk

GRAF PIF Documentation

Patient less than 12 months

is considered developmental

high risk for falls.

GRAF PIF Documentation

Required interventions will be listed in the hover mechanism based on patient’s total score

Total score will auto-calculate and be listed

here

Procedure

• Standard Interventions should be implemented for pediatric patients with fall assessment total score of less than 2

• HIGH Risk Interventions should be implemented for pediatric patients with a fall assessment total score of 2 or greater

All infants below 12

months are considered a developmental

HIGH RISK

Procedure

• If patient meets criteria for HIGH Risk fall precautions according to GRAF PIF tool (score >2), complete the following: All standard fall risk interventions

Review inpatient safety education

Place yellow “Falls Precaution” armband on patient

Post yellow “Tippy Turtle” Fall Precaution sign on patient’s door

Place nonskid footwear on patient

Check “Safe Room Set Up” with each change of shift

Hourly safety rounding

Include falls status in daily rounding

Consider additional staff support when assisting patient

Targeted Fall Prevention Interventions Targeted interventions are listed in the hover

for patients at increased risk of falls specific to

each category

Targeted Fall Prevention Interventions

Targeted interventions are listed in the hover for patients at increased risk of falls specific to each category

Remember to utilize the hover boxes, if score is high risk in any category, it is understood

that targeted interventions within the hover are completed

Infants at Developmental High Risk Targeted Fall Prevention Interventions

Patients less than 12

months are considered developmental high risk

for falls. Targeted interventions are listed

in the hover for patients less than 12 months

Infant Fall Risk Precautions

• Patients less than 12 months of age are considered a developmental fall risk; complete the following precautions: Review developmental falls safety education with family

Do not leave baby unattended on high surfaces, such as bed, table or couch

Do not place the baby in a bouncy seat on high surfaces

Utilize straps in bouncy seats, swings, and car seats

Hourly safety rounding Check patient’s position

Check patient’s pain level

Check patient’s potty status

Check patient’s possessions in reach

Check parent (or adult) present

Check safe room set-up at shift change If ambulatory, clear walkway (no tubing/cords)

Crib in lowest position

Crib with all rails up

Linens, toys off floor

Standard Fall Risk Precautions

• If patient meets criteria for Standard fall precautions according to GRAF PIF tool (score of 1 or below), complete the following: Orient patient/family to room, call light

Place patient in appropriate crib/bed for developmental age

Set crib/bed in lowest position, unless contraindicated, with the brakes on

Crib rails to highest level

Bed rails up X2

Non-skid footwear for ambulating patients

Patients in alternative baby furniture are secured with original product securing device

Call light within reach

Educate the patient/family on falls safety

HIGH Fall Risk Precautions

• If patient meets criteria for HIGH Risk fall precautions according to GRAF PIF tool (score >2), complete the following: All standard fall risk interventions

Review inpatient safety education

Place yellow “Falls Precaution” armband on patient

Post yellow “Tippy Turtle” Fall Precaution sign on patient’s door

Place nonskid footwear on patient

Check “Safe Room Set Up” with each change of shift

Hourly safety rounding

Include falls status in daily rounding

Consider additional staff support when assisting patient

Safe Room Set-Up

Bedside table within reach

All side rails up, bed at lowest level

IV Pole on patient’s strong side

Nurse call light button/remote control in reach

Floor free of toys/extra equipment

Attentive parent at bedside or staff checking on patient and environment every hour

No cords/tubing draped across

walkways

“Unsafe” Room Examples

Patient alone

Bed in raised position, no side rails up

Bedside table, remote, and nurse call button out of

reach

Toys or items from home on

floor

Cords stretched

across walkways or tangled Rugs or linens

on the floor

IV pole too far from patient or on their weaker side

Unnecessary equipment in room

Emergency Department

ED OUTPATIENTS

• All patients considered high risk, complete the following: All standard fall risk interventions

Review inpatient safety education

Place nonskid footwear on patient

Check “Safe Room Set Up” with each change of shift

Hourly safety rounding

Include falls status in daily rounding

Consider additional staff support when assisting patient

ED INPATIENTS

• Interventions based on GRAF PIF scoring

PICU/PCICU

Critical care patients • Complete GRAF PIF scoring

• Implement targeted interventions based on category scoring (refer to hover)

• Also complete the following: All standard fall risk interventions

Review inpatient safety education

Place nonskid footwear on patient

Check “Safe Room Set Up” with each change of shift

Hourly safety rounding

Include falls status in daily rounding

Consider additional staff support when assisting patient

Acute care (boarded) patients

• Interventions based on GRAF PIF scoring

Summary

• Fall risk assessments should be completed on all patients and appropriate interventions implemented

• The patient with a fall risk score of >2 should always be placed on High Risk fall precautions

• Remember: failure to provide a safe environment place the patient at higher risk for falls

Thank you for your efforts to keep our patients

safe from falls!